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Radial Neck Fracture: Causes, Symptoms & Treatment
A radial neck fracture is a break in the neck of the radius bone near the elbow joint. It most commonly results from a fall onto an outstretched hand.
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A radial neck fracture is a break in the neck of the radius bone near the elbow joint. It most commonly results from a fall onto an outstretched hand.
What Is a Radial Neck Fracture?
A radial neck fracture is a break that occurs at the neck of the radius (the forearm bone on the thumb side), just below the radial head near the elbow joint. It is one of the more common elbow injuries, particularly in children and older adults. Depending on the degree of displacement and angulation of the bone fragment, the fracture is classified into different grades of severity.
Causes
The most common cause of a radial neck fracture is an indirect trauma, such as a fall onto an outstretched hand. This transmits a compressive and valgus force to the elbow, driving the radial head against the capitellum of the humerus and resulting in a fracture of the radial neck. Other causes include:
- Direct blows to the elbow
- Sports accidents (e.g., inline skating, cycling)
- Road traffic accidents
- Osteoporosis as a contributing factor in older patients
Symptoms
Typical symptoms of a radial neck fracture include:
- Pain on the lateral side of the elbow, especially during movement
- Swelling and possible bruising around the elbow
- Restricted range of motion, particularly when rotating the forearm (pronation and supination)
- Tenderness on palpation over the radial head
Diagnosis
Diagnosis is typically established through clinical examination and imaging:
- X-ray of the elbow in two planes: the standard method to visualize the fracture and assess angulation
- Computed tomography (CT): used in complex or unclear fractures to evaluate fragment position in detail
- Magnetic resonance imaging (MRI): useful when associated injuries such as ligament tears or cartilage damage are suspected
In children, the O'Brien classification is frequently used, while in adults the Mason classification helps guide treatment decisions based on fracture severity.
Treatment
Conservative Treatment
Non-displaced or minimally displaced fractures (e.g., Mason Type I) are generally managed conservatively. This includes:
- Immobilization with a plaster splint or functional brace for approximately 1–2 weeks
- Pain management with analgesics (e.g., ibuprofen, paracetamol)
- Early physiotherapy exercises to restore range of motion
Surgical Treatment
More significantly displaced or unstable fractures (Mason Types II–IV) often require surgical intervention:
- Closed reduction and fixation with Kirschner wires (especially in children)
- Open reduction and internal fixation (ORIF) using screws or plates
- Radial head resection: removal of the radial head in cases of non-reconstructable comminuted fractures (more common in older patients)
- Radial head prosthesis: replacement of the radial head in complex fractures with associated instability
Prognosis and Rehabilitation
With timely and appropriate treatment, the prognosis for a radial neck fracture is generally favorable. Children tend to achieve better functional outcomes than adults due to their remodeling potential. Physiotherapy plays a central role in restoring elbow strength and mobility. Full recovery typically takes several weeks to months, depending on fracture severity and the chosen treatment approach.
References
- Rommens, P.M. et al.: Fractures of the Elbow. In: Wirth, C.J. (ed.): Practice of Orthopaedics and Trauma Surgery. Thieme, Stuttgart, 2014.
- Kaplan, L.J. et al.: Radial Head and Neck Fractures. In: Orthopedic Clinics of North America, 2013; 44(3):345–355. DOI: 10.1016/j.ocl.2013.03.005.
- Schmittenbecher, P.P.: Radial Neck Fractures in Children. Unfallchirurg, 2005; 108(7):593–602. DOI: 10.1007/s00113-005-0926-6.
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